Organization
366TH MEDICAL GROUP SGSL
Active
Other names
MT HOME OP PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
90 HOPE DR, BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1057
(208) 828-7480
(208) 828-3785
Mailing address
90 HOPE DR, BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1057
(208) 828-7480
(208) 828-3785
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
333600000X
Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021727
PK
—
Enumeration date
09/20/2006
Last updated
02/08/2016
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